Bacon's Rebellion

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COPN – Don’t Leave Home Without It

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sherlockj
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by James C. Sherlock

Sometimes I think we don’t personalize the effects of Virginia’s Certificate of Public Need (COPN) program on individual Virginians in ways that are relatable. Nor do many understand the power of the hospital monopolies.

Many readers here have followed the progress of our reporting of the increasing and relentless suppression of competition in healthcare by COPN. I will offer in this essay a single example that may personalize it.

In 2009, the regulation, not the law, that defined the radius from your home of facilities that would be considered when seeing whether you are adequately served by existing open heart surgery facilities was changed as follows:

Title 12. Health » Agency 5. Department Of Health » Chapter 230. State Medical Facilities Plan » Part IV. Cardiac Services

Article 2
Criteria and Standards for Open Heart Surgery

12VAC5-230-440. Accessibility Travel time.

A. Open heart surgery services should be within 30 60 minutes driving time one way, under normal conditions, of 95% of the population of a the [ health ] planning district [ using mapping software as determined by the commissioner ].

Simple change. Thirty minutes was changed to 60 minutes. You surely did not notice. You were meant not to notice. And your elected representatives were not asked to vote on it.

The regulation was changed to reflect that you, as a citizen, were well served with a sixty=minute drive to a facility which could perform open heart surgery as opposed to the 30-minute drive in the previous regulation.

Certainly the hospitals offering open heart surgery were more than fine with it.

When one doubles the radius of the circle from one unit to two, the area of the circle goes from 3.1416 square units to 12.5664 units. It quadruples.

So the chance of, say, your closest hospital getting a certificate to create an open heart surgery service just collapsed.

If that is OK, and it might be, we could at least expect a footnote explaining why it is so.

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12 responses to “COPN – Don’t Leave Home Without It”

  1. Top-GUN Avatar
    Top-GUN

    Government picking Winners and Losers… what’s not to like

  2. V N Avatar
    V N

    Capt., is the law changed for other items, not just open heart surgery?

    1. Steve Haner Avatar
      Steve Haner

      And given how well that medical situation is tracked, what has been the impact on heart attack outcomes? It has been more than 10 years now.

      1. sherlockj Avatar
        sherlockj

        I don’t know. More importantly, neither does the Virginia Department of Health’s Division of COPN. They are neither tasked nor funded to track outcomes of their decisions.

      2. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        The death rate from cardiovascular disease has fallen in Virginia since 2009.
        https://vaperforms.virginia.gov/healthFamily_mortalityLongevity.cfm#one

        https://vaperforms.virginia.gov/Graphics/Cardiovascular-RatebyRegion.png

  3. Nancy_Naive Avatar
    Nancy_Naive

    COPD — Can’t leave home with it.

  4. TooManyTaxes Avatar
    TooManyTaxes

    CPON should be tied to price and profit regulation. Otherwise, one sees monopoly pricing. Maybe the new AG (federal) will file an antitrust suit against the medical facilities.

  5. Steve Haner Avatar
    Steve Haner

    Remember reading in a book on health care issues (Cato Institute?) about a cardiology outcome study. The outcomes improved when the docs were on vacation, with the guess being fewer unnecessary tests, procedures, stents, etc. They put in lots of stents these days. While the rules allow somebody to be 60 miles from an OR rated for open heart surgery, that is not the same as being 60 miles from an emergency department well prepared to stabilize a cardiac event or stroke. If they do not base this on the outcomes, then shame on them. But I bet somebody has that info. Having had that surgery myself (twice, almost), I don’t want some doc who is not totally specialized – a general chest cutter should not do it.

    1. sherlockj Avatar
      sherlockj

      Point is, Steve, is that it is up to the VDH to know those answers, not you and me. Unfortunately, outcomes never factor into COPN, just capacity.

  6. paulmmurphy Avatar
    paulmmurphy

    COPN are indeed something to think about. Do they do more harm than good? Who are they for?

    A couple of thoughts on points raised here . . .

    1. It would be somewhat uncommon to ride an ambulance straight from where you were stricken to the site of an open heart surgery unit.

    2. Even if the area of that circle has quadrupled the longest possible ride has still just doubled.

    For full disclosure, I personally enjoy the benefits of being covered by Medicare and would like to see those benefits extended to ALL as in Medicare-for-all. Long overdue and the lack is holding our country back.

    1. sherlockj Avatar
      sherlockj

      If your ambulance ride takes you to an ER in a hospital that does not offer open heart surgery and you need it, you will have to be transported to a hospital that does. Not sure that is what you are looking for.

    2. TooManyTaxes Avatar
      TooManyTaxes

      Keep your hands off my health insurance. While over 65, my wife and I only have the mandatory Medicare Part A. We don’t have Medicare Part B and don’t want it. We have the Federal Employees Health Plan through BC/BS. It is much more cost-efficient for us than other options that include Medicare Part B.

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